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Fight against discriminative MIGS funding to continue

Ophthalmologists and stakeholders will continue to rally against the “two classes of glaucoma patients” that current Medicare access for minimally invasive glaucoma surgeries (MIGS) has created.

Last week the Medical Services Advisory Committee (MSAC) ruled MIGS devices would be permanently covered under the new Medicare Benefits Schedule (MBS) item 42705 from November 1. However, it will still only be available to patients when the procedure is performed alongside cataract surgery, despite requests for greater access from glaucoma experts.

The cost of the surgery will increase to $911.10 with a patient benefit of 75% ($683.35) in private procedures, and 85% ($774.45) otherwise. Previously, surgeons had essentially been implanting MIGS devices for free as the fee for the interim MBS number was the same as cataract surgery alone.

“The best case scenario would be MSAC accepting the reality on the ground and moving ahead.”

Ashish Agar, ASO

Australian Society of Ophthalmologists (ASO) vice-president and Sydney glaucoma surgeon Dr Ashish Agar – who lobbied Federal Health Minister Mr Greg Hunt in February – wanted MSAC to be extended. He believes the status quo is unfair on glaucoma patients who don’t need cataract operations or who had previously already had the surgery.

“Certainly the most popular method is as a combined procedure with a cataract procedure, so it’s great for those patients. However, we are only half way there because it is still creating two classes of glaucoma patients,” Agar said, adding that standalone MIGS had proved to be “the wonder operation” in a critical number glaucoma of patients who had exhausted all other avenues in treatment.

“Arguably these are the patients who need [MIGS] the most, in other words where glaucoma is the primary problem, they still can’t access the device,” he said.

“The best case scenario would be MSAC accepting the reality on the ground and moving ahead.”

The Department of Health justified its position earlier this year by saying between February 2014 and May 2017 MIGS was co-claimed with cataract surgery in 91% of cases.

Agar believed MSAC’s decision to exclude standalone operations wasn’t financially motivated, but a data problem – when the evidence was compiled it was primarily focused on the combined cataract procedure. However, he believed since then ophthalmologists have obtained a clearer picture of the true benefit of standalone MIGS procedures.

Previously, MIGS was covered under MBS item 42758 (goniotomy), but the government restricted that in May 2017, after technology advances led to a substantial increase in its use and subsequent billing through Medicare. This prompted the recent review and now the creation of its own specific MBS number.